Estimated reading time: 12 minutes
Table of contents
- What is an Independent Medical Examination (IME) in New Jersey?
- What Happens After an IME in a New Jersey Workers’ Comp Case?
- Can the IME Doctor’s Opinion Be Challenged?
- What to Do If Your Benefits Are Cut Off After an IME
- How a New Jersey Workers’ Comp Attorney Can Help You After an IME
- Frequently Asked Questions About IMEs in New Jersey Workers’ Compensation
- Protect Your Rights After a Workers’ Comp IME in New Jersey
Many workers’ compensation claimants in New Jersey are unfamiliar with the process of an Independent Medical Examination, commonly referred to as an IME, following a workplace injury. An IME can be one of the most daunting aspects of a workers’ compensation claim and it is natural to wonder what will happen after the IME.
Pellettieri Rabstein & Altman have been representing workers injured on the job in New Jersey since 1929. Our attorneys know how an IME report can be used against a worker and how a well-informed and skilled attorney can counter such a report and protect the rights of an injured worker.
What is an Independent Medical Examination (IME) in New Jersey?
Before covering what happens after an IME, it helps to understand what the examination is. In New Jersey workers’ compensation cases, an IME is a medical evaluation ordered by your employer’s insurance carrier. Despite the word “independent,” the doctor conducting the examination is typically selected and paid for by the insurer, not by you.
First the doctor reviews your complete medical record. Then the doctor performs a very short physical examination and writes a report including his conclusions regarding the extent of injury that he believes you have sustained, your current physical capabilities, and whether or not you require on-going treatment for your work-related injuries.
What Happens After an IME in a New Jersey Workers’ Comp Case?
After an IME has been conducted the process of going forward for your case can have several outcomes depending on the findings of the IME. The process from IME to benefits for your case can include the following steps:
1. The IME Doctor Prepares a Written Report
The examining physician will draft a formal report summarizing their findings. This document typically addresses:
- Whether your injury is work-related
- The nature and extent of your injury
- Your current level of disability (temporary or permanent)
- Whether you have reached maximum medical improvement (MMI)
- Medical care that you need and whether or not additional medical treatment will be required for your work-related injury
- Any work restrictions the claimant has, and the ability to return to work
This report is typically mailed to the insurance company and copies are usually sent to all parties including your attorney if you are represented by a workers’ compensation lawyer.
2. The Insurance Carrier Reviews the Report
The insurer reviews the IME findings and uses them to make key decisions about your claim, including:
- Whether to continue paying your temporary disability benefits or not
- Whether to authorize or deny additional medical treatment
- Whether you have a permanent disability and what degree of disability you have
- How much to offer you to settle your work injury claim
This is why an IME report that is good for the insurance company can lead to the cutting off of your benefits, denial of needed medical treatment and even a very low settlement offer. This is why it is so very important to have a workers’ comp attorney representing you when you receive an IME report.
3. Your Treating Physician May Respond
Just as an IME report is likely to be favorable to the insurance carrier, the report can be challenged by the report of your treating physician. In many cases, the report of your treating physician will contradict that of the IME doctor. In such cases, your doctor should prepare a report in which he sets forth his conclusions with respect to your injuries and your ability to return to work, and in which he challenges the conclusions of the IME doctor.
Your attorney can work with your doctor to get them to write a report which outlines in detail the basis for their conclusions and how they differ from those set forth in the IME report. This report becomes part of the evidence in the case and is a way for your treating physician to “reply” to the IME report.
4. The Case May Proceed to Formal Hearings
If the matter cannot be resolved, the case will proceed to a formal hearing(s) in front of a Workers’ Compensation Judge. The Judge will review all of the medical evidence entered into the record, including the report of the IME as well as reports and testimony from treating physicians. A determination will then be made as to the matters at issue in the case.
The lawyers at PR&A Law have decades of experience presenting medical evidence in workers’ compensation cases throughout New Jersey before workers’ compensation judges.
5. A Settlement or Award Is Reached
Ultimately, your workers’ comp case will resolve either through:
- Settlement: A negotiated agreement between you and the insurance company to your work injury claim which is typically paid out in a lump sum of money.
- Formal Award: After hearing the evidence, the Judge would enter an Award determining the degree and percentage of permanent partial disability for which the employer and carrier are responsible to pay on an ongoing basis.
The IME report will ultimately play a significant role in how your workers’ compensation case is resolved. While an unfavorable report can close the doors on payment of temporary disability benefits and of medical treatment as well as result in an unfavorable permanent partial disability award, it is not necessarily the end of the road for the injured worker. However, it is critical that the report be challenged as soon as possible by skilled workers’ compensation attorneys.
Can the IME Doctor’s Opinion Be Challenged?
Are IME Doctors biased against injured workers? IME doctors are hired and paid by insurance companies and therefore in many cases attempt to downplay the severity of a worker’s injuries in their reports. What can you do if your IME report is unfavorable to you?
- Counter-evaluate: Your attorney will obtain an independent medical evaluation or report by and through your treating physician or other qualified physician of your choosing.
- Challenge the IME Doctor’s Qualifications and Past Behavior: There are many physicians who are hired as IME’s on a regular basis who consistently produce reports that are favorable to the insurance company. It is very important to have an attorney review the report to determine if the IME doctor is qualified to render an opinion on your specific case and to review the IME doctor’s past reports to determine if he or she consistently takes a position that is favorable to the insurance company.
- Cross-examine the IME physician: In formal hearings, our workers’ compensation attorneys can challenge the IME physician’s report during his or her deposition, or cross-examine the physician at the hearing. In either case, we will challenge any inconsistencies, or any failure on the part of the IME physician to conduct a complete and adequate examination.
- Present testimony and evidence from your treating physician(s): He or she can explain your medical condition, and present evidence from your long-term treatment records.
At PR&A Law, we take on cases where our clients have been given an unfavorable report from an IME, and we expose the weaknesses of the report in order to get our clients the benefits that they are entitled to.
What to Do If Your Benefits Are Cut Off After an IME
Many people are shocked when, after a workers’ compensation IME in New Jersey, they are immediately advised that their temporary disability benefits are being cut off. This is often as a result of the IME doctor’s report which states that the worker has reached maximum medical improvement or that the work-related injury was not in fact work-related.
Don’t delay! If your temporary disability benefits have been wrongly stopped, you need a New Jersey workers’ compensation attorney to fight for your rights in order to try to get your benefits back.
- File an application with the Division of Workers’ Compensation to contest the termination
- Request a formal hearing before a workers’ comp judge
- Obtain medical evidence that contradicts the IME doctor’s conclusions
- Pursue interim relief if you are facing immediate financial hardship
The workers’ compensation attorneys at PR&A Law have been handling these situations for generations. We understand the tactics insurance companies use, and we know how to fight back effectively.
How a New Jersey Workers’ Comp Attorney Can Help You After an IME
Whether the report comes back favorable to you or not, having a skilled workers’ compensation attorney like those at PR&A Law by your side to protect your interests as you go through the post-IME process is crucial. Here is how PR&A Law helps clients navigate the post-IME phase of their workers’ compensation cases:
- Careful review of the IME report: We scrutinize every conclusion reached in the report for inaccuracies, omitting relevant information and opinions that exceed the scope of a brief medical examination.
- Determining whether to accept a settlement offer made by the insurer based on the IME report: Whether the results of the IME report are favorable or unfavorable to you, we will help you to understand whether the settlement offer made by the insurer is fair or not and when it would be in your best interest to try to get more.
- Coordinate with your treating physicians: PR&A Law works with your treating physicians to position their opinions and medical records as counter-evidence to the IME report.
- Represent you at a hearing: Our attorneys can appear before a Workers’ Compensation Judge in any location in New Jersey to argue your case.
Defending your right to continue treatment: If the IME is used to deny certain treatments then we can fight to get you the continued medical care you need to recover from your work-related injury.
Frequently Asked Questions About IMEs in New Jersey Workers’ Compensation
Q: Do I have to attend an Independent Medical Examination in New Jersey?
Generally, yes. By statute, an injured worker is required to attend an IME requested by an insurer. Refusal to attend scheduled IME’s can result in a workers’ compensation carrier denying an injured worker’s right to receive compensation for work related injuries or illness. This does not mean that an injured worker has no rights. He or she has the right to have their attorney informed of the time and place of scheduled examination(s). The injured worker also has the right to have taken appropriate steps to protect his or her interest before, during and after scheduled IME’s.
Q. Who pays for an Independent Medical Examination in a workers’ compensation case in New Jersey?
The employer’s insurance carrier pays for your Independent Medical Examination required as part of the New Jersey workers’ compensation process. The insurance company chooses the examining doctor. Therefore, the doctor chosen is in the position of objectivity only.
Q: How long does it take to receive the report from an Independent Medical Examination (IME) for a workers compensation claim in New Jersey?
IME reports are typically generated and produced within a few weeks after an IME examination. The report is then typically acted upon by the insurance carrier in a matter of days or so after receipt of the same. It is therefore very important to have an attorney monitoring your case on your behalf throughout the process to ensure that your rights are being protected and that any actions taken by the insurance carrier are appropriate.
Q: Can you bring someone with you to your IME in New Jersey?
It is your right to have a representative, (such as a friend or relative), present at your Independent Medical Examination. We can advise you on whether or not you can bring a representative with you to the examination. It is also very important that you have adequate representation prior to the IME so that you are aware of your rights and can be advised as to how to present your condition in the best possible light.
Q: My IME doctor says that I can return to work. But my treating doctor disagrees. What should I do?
If your treating doctor does not agree with the IME doctor’s findings that you can return to work then the Workers’ Compensation judge will look at both doctors’ opinions. However, the opinion of your treating doctor is likely to carry more weight than that of an IME doctor if your treating doctor has treated you and observed your limitations for a long period of time.
Q: What happens after an IME if I disagree with the results?
You have the right to challenge an IME report in the New Jersey Division of Workers’ Compensation. Typically, your attorney will file and serve a petition to dismiss or to correct the report. Then, your attorney will gather and present other evidence to contradict the report. Your attorney will also represent you at any hearings before a workers’ compensation judge on the petition. It is crucial that you act quickly in such circumstances, as delays can harm your position.
Q: Does an IME determine my permanent disability rating in New Jersey?
A single IME is not determinative of a worker’s permanent partial disability rating. As with other medical evidence, the treating physician’s assessment of a worker’s functional limitations as well as objective evidence of a worker’s impairment can be used to counter an IME finding of full medical recovery or to challenge an IME’s rating of a worker’s permanent impairment.
Protect Your Rights After a Workers’ Comp IME in New Jersey
An Independent Medical Examination can be a critical moment in time for a New Jersey workers’ compensation claimant as the report generated by the examination can affect workers’ compensation benefits, workers’ compensation treatment and the financial well-being of a claimant.
For almost 100 years, Pellettieri Rabstein & Altman has represented injured workers throughout New Jersey in their pursuit of workers’ compensation benefits. We have the experience, knowledge and resources to challenge negative findings from IME’s and work aggressively to ensure that our clients receive all of the benefits and treatment that they are entitled to under New Jersey law.
Contact PR&A Law today for a free consultation. We have five offices in New Jersey to serve the workers’ compensation needs of our clients, including Cherry Hill, Lawrence Township, Morristown, Nutley, and Trenton. Our lawyers represent injured workers from all over New Jersey and fight to get them the full workers’ compensation benefits they are entitled to by law.
